Healthcare Provider Details

I. General information

NPI: 1821795402
Provider Name (Legal Business Name): REBECCAH RODRIGUEZ REGNER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 SAXONY RD
ENCINITAS CA
92024-6775
US

IV. Provider business mailing address

171 SAXONY RD
ENCINITAS CA
92024-6775
US

V. Phone/Fax

Practice location:
  • Phone: 760-846-1654
  • Fax:
Mailing address:
  • Phone: 760-846-1654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE BUTLER
Title or Position: OWNER
Credential:
Phone: 415-713-4341